Polyuria can appear as part of developing diabetes or can be a result of other issues. IIn this blog post I’ll focus on undiagnosed UTI as a common driver of overactive bladder syndrome (OAB). This is often seen in functional medicine practice but may be underappreciated.
Individuals with an overactive bladder in a functional medicine setting often have an underlying bladder wall inflammation. This may be from a previous infection, from an oxalate sensitivity, or another cause. Whatever the cause of the inflammation, chronic bladder wall inflammation is likely to stimulate nerve endings in the bladder wall to fire. If stretch receptors fire signals into the brain, the signal will be interpreted in the brain as stretch, even if irritation, not stretch, was the stimulus that got the stretch receptor attached to that nerve to fire. This is the same effect as when you rub your eyes and see colors. The nerve endings are being stimulated by a stimulus other than the one associated with that nerve. When the person feels sensations that give them the feeling that the bladder wall is stretched (full), they will have the urge to void urine.
Now, assuming the bladder is not in fact full of urine (as it would be in developing diabetes for example), the question is, “What is making the bladder wall inflamed?”
Active Urinary Tract Infection
It is common for the person to have a chronic low-level UTI. This is extremely common in elderly people and is often missed, particularly if the patient’s capacity for communication is impaired, or if their capacity to discern sensory signals is impaired. With infection, it’s common that bacteria will form a biofilm that makes them adherent to the bladder wall. The first problem with a biofilm is that it makes the bacterial infection difficult to eradicate, as organisms deep in the biofilm go dormant, so they don’t ingest the antibiotic. When the antibiotic course is over, with enough time and random re-activation, the surviving organisms gradually regrow the bacterial colony. This causes the UTI to be recurring. Th1 immune deficiency is a big underlying imbalance we often see with recurring infections. The colony will still be susceptible to the same antibiotic or natural agents, since the surviving organisms will not have eaten the previous round of antibiotic, so they won’t have formed resistance. That means that when a person tells you the same antibiotic always helps them get over their UTI, you should suspect a biofilm.
From the perspective of OAB, the concern is that infection is inflammatory. And with a biofilm, the concern is that the organisms in contact with the wall of the bladder, at the base layer of the biofilm, instead of going dormant, will irritate the bladder wall and when an inflammatory exudate forms, the organisms will eat the exudate in order to survive. So, the infectious agents are instigating inflammation of the bladder wall directly.
If there is an active infection, the first step is to address the infection. It’s also important to address the biofilm component of the infection. Thyme, stevia, NAC, ginger, oregano, quercetin, berberine, artemesia, lemongrass, clove, garlic, and a host of other agents have biofilm disrupting properties and each work effectively for specific pathogens.
One might imagine that it would not be useful to repeat the use of an agent that didn’t fully eradicate a UTI on previous attempts. However, the opposite is often the case. The fact that an agent or combination of agents knocked down the bacterial colony count suggests that it was at least partly effective. The task is to determine if using that same approach, combined with biofilm disruptors, is more effective. A biofilm disruptor will degrade the structural integrity of the biofilm, increasing penetrance of the agent(s) you’re using to kill the pathogen.
It’s noteworthy that biofilm-based infections are typically characterized by strong adherence to the bladder wall and a highly organized biofilm matrix in which the pathogenic organisms are embedded. This mean that the person may have suprapubic pain and burning upon urination, but a negative urine culture, since the organisms involved in the infection are not coming down into the urine. It is occasionally useful to give a biofilm disruptor before doing a urinalysis, but often the urinary analysis is nonetheless negative. Getting treatment for a UTI, despite the negative urine analysis, is often useful.
As Dr. Yanuck states: “It’s also important to understand that that some organisms are “viable but not culturable.” Biofilm researchers refer to these as VBNC’s. William Costerton, the father of biofilm research, used to describe scraping infectious exudate out of diabetic foot wounds and trying to culture it, often unsuccessfully. Successful culture depends on finding the correct culture medium for growing a particular organism. Standard culture media often won’t grow what’s growing in the person.”
Biofilm with Residual Organisms
It’s also possible that the individual has a low level of chronic inflammation, driven by a biofilm-based infection in which a small enough number of pathogenic organisms is present, embedded in a biofilm. This might not be considered an infection if the pathogen counts are not high enough. For example, a person who was treated with an antibiotic several months ago for a UTI may now be in a position in which the pathogen count is very low but rising slowly. You can often see this kind of gradual reemergence in other infections like sinus infections or diverticulitis. As with the bladder, the key point is that the same antibiotic will work to knock back the infection each time, as discussed above. Treatment can be similar to that for a UTI, with a combination of substances to address the pathogenic organisms, coupled with biofilm disruptors. work with your practitioner for a complete protocol.
Other Factors
As is true of many disease processes, it’s necessary for your practitioenr to inventory your case as a whole to understand other contributors to the bladder wall inflammation. The individual may have problems with histamine elevation, driving bladder wall mast cell degranulation or they may have an oxalate issue. Or they may have a pattern of pain sensitization. If a painful neuropathy is part of the picture, it becomes important to use perilla to inhibit interleukin-4 (IL-4). Astragalus has also been shown to be useful to downregulate chronic pain. If the WBC count is low, as is common with chronically ill individuals, it can be essential to raise it with zinc, medicinal mushrooms and so forth.
Address T Cell Polarization
If the person has chronic susceptibility to infections, consider support for adequate Th1 and NK cell function with Berberine, baicalin and glutathione. Th2 dominance is a barrier to adequate Th1/NK cell activation. If the person is Th2 dominant, downregulating Th2 will be suitable as well with perilla and astragalus. In some individuals, inflammation of the bladder wall epithelia will drive the production of Th2-promoting cytokines, making it difficult to mount an adequate Th1/NK cell response with which to eradicate pathogens so balancing the immune system is crucial to improve the symptoms.